Defecation Function After Laparo-Assisted Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis for Ulcerative Colitis

• Published in: Journal of laparoendoscopic & advanced surgical techniques. Part A
• Main Authors: Hagihara, Kiyotaka, Mori, Ryota, Sekido, Yuki, Ogino, Takayuki, Hata, Tsuyoshi, Takahashi, Hidekazu, Miyoshi, Norikatsu, Uemura, Mamoru, Doki, Yuichiro, Eguchi, Hidetoshi, Mizushima, Tsunekazu
• Format: Journal Article
• Language: English
• Published: United States 27.09.2021
• Subjects: defecation function; ileal pouch anal anastomosis; ulcerative colitis restorative proctocolectomy
• ISSN: 1557-9034
• DOI: 10.1089/lap.2021.0465

Defecation status is an important determinant of quality of life. Previous studies showed that postoperative defecation disorders occurred after open surgery for ulcerative colitis (UC), but few have investigated defecation status after laparo-assisted surgery. The added precision and magnification provided with laparo-assisted surgery should lead to less damage to the anal sphincter muscle. This study investigated defecation function after a laparo-assisted restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA). We also clarified factors that worsened defecation status. This retrospective study included 57 patients who underwent laparo-assisted RPC with IPAA for UC from January 2000 to May 2019. At 1 year after surgery, functional outcomes were evaluated with the Kirwan classification and Wexner score. Risk factors for poor defecation status were investigated with multiple regression. At 1 year after surgery, the median Kirwan classification score was 2 and the median Wexner score was 8. Defecation disorder was observed in 19 (33.3%) patients, according to the Kirwan classification, and 15 (26.3%) patients, according to the Wexner score. Hand-sewn IPAA was associated with defecation disorder (  = .04), evaluated with the Kirwan classification. Hand-sewn IPAA (  = .01), older age (  = .03), high body mass index (  = .04), and the surgical indication (cancer/dysplasia;  = .03) were significantly associated with defecation disorder, evaluated with the Wexner score. The multivariable analysis showed that hand-sewn IPAA was an independent risk factor (  = .049; odds ratio: 4.99; 95% confidence interval: 1.0-28.39). We found that hand-sewn IPAA was a risk factor for defecation disorders after laparo-assisted RPC for UC.